Fronto-cerebellar Fiber Tractography in Pediatric Patients Following Posterior Fossa Tumor Surgery

Overview

Journal Childs Nerv Syst

Specialty Pediatrics

Date 2012 Nov 28

PMID 23184224

Citations 32

Authors

Verena Soelva

Pablo Hernaiz Driever

Alexander Abbushi

Stefan Rueckriegel

Harald Bruhn

Wilhelm Eisner

Ulrich-Wilhelm Thomale

Affiliations

Soon will be listed here.

Abstract

Objective: Fronto-cerebellar association fibers (FCF) are involved in neurocognitive regulatory circuitry. This may also be relevant for cerebellar mutism syndrome (CMS) as a complication following posterior fossa tumor removal in children. In the present study, we investigated FCF by diffusion tensor imaging in affected children and controls.

Methods: Diffusion-weighted MR imaging at 3 T (GE) allowed tractography of FCF using a fiber tracking algorithm software (Brainlab 2.6) in 29 patients after posterior fossa tumor removal and in 10 healthy peers. Fiber tract volumes were assessed and fiber signals were evaluated in a semiquantitative manner along the anatomical course.

Results: Volumes of FCF revealed significant diminished values in pediatric patients with symptoms of CMS (19.3 ± 11.7 cm(3)) when compared with patients without symptoms of CMS (26.9 ± 11.9 cm(3)) and with healthy peers (36.5 ± 13.82 cm(3)). In medulloblastoma patients, the volume of FCF was also significantly reduced in patients with symptoms of CMS despite having the same antitumor therapy. In semiquantitative analysis of the fiber tract signals, differences were observed in the superior cerebellar peduncles and midline cerebellar structures in patients with symptoms of CMS.

Conclusion: Using DTI, which allows the visualization of fronto-cerebellar fiber tracts, lower FCF tract volumes and diminished fiber signal intensities at the level of the superior cerebellar peduncles and in midline cerebellar structures were identified in patients with postoperative symptoms of CMS. Our study refers to the role of a neural circuitry between frontal lobes and the cerebellum being involved in neurocognitive impairment after posterior fossa tumor treatment in children.

Citing Articles

Neuroimaging of postoperative pediatric cerebellar mutism syndrome: a systematic review.

Obdeijn I, van Baarsen K, Avula S, Toescu S, Lequin M, Hoving E Neurooncol Adv. 2025; 7(1):vdae212.

PMID: 39777259 PMC: 11705075. DOI: 10.1093/noajnl/vdae212.

Neuroanatomy of cerebellar mutism syndrome: the role of lesion location.

Skye J, Bruss J, Toescu S, Aquilina K, Grafft A, Bardi Lola G Brain Commun. 2024; 6(4):fcae197.

PMID: 39015767 PMC: 11250198. DOI: 10.1093/braincomms/fcae197.

Cerebellar mutism syndrome caused by bilateral cerebellar hemorrhage in adults: a case report and review of the literature.

Zedde M, Grisendi I, Assenza F, Napoli M, Moratti C, Cecco G Neurol Sci. 2024; 45(9):4161-4171.

PMID: 38724752 DOI: 10.1007/s10072-024-07571-z.

Diffusion Tensor Imaging Technique Delineating the Prognosis for Cerebellar Mutism in Posterior Fossa Tumors: A New Tool.

Sinha V, Ankur P, Gaurav J Acta Neurochir Suppl. 2023; 135:53-59.

PMID: 38153449 DOI: 10.1007/978-3-031-36084-8_10.

Spatiotemporal changes in along-tract profilometry of cerebellar peduncles in cerebellar mutism syndrome.

Toescu S, Bruckert L, Jabarkheel R, Yecies D, Zhang M, Clark C Neuroimage Clin. 2022; 35:103000.

PMID: 35370121 PMC: 9421471. DOI: 10.1016/j.nicl.2022.103000.

References

Turgut M . Re: the pathophysiologic mechanism of cerebellar mutism (Ozgur et al. Surg Neurol 2006;66:18-25). Surg Neurol. 2007; 68(1):117. DOI: 10.1016/j.surneu.2007.03.034. View

Gudrunardottir T, Sehested A, Juhler M, Grill J, Schmiegelow K . Cerebellar mutism: definitions, classification and grading of symptoms. Childs Nerv Syst. 2011; 27(9):1361-3. DOI: 10.1007/s00381-011-1509-7. View

Nagaratnam N, Nagaratnam K, Ng K, Diu P . Akinetic mutism following stroke. J Clin Neurosci. 2003; 11(1):25-30. DOI: 10.1016/j.jocn.2003.04.002. View

Ronning C, Sundet K, Due-Tonnessen B, Lundar T, Helseth E . Persistent cognitive dysfunction secondary to cerebellar injury in patients treated for posterior fossa tumors in childhood. Pediatr Neurosurg. 2005; 41(1):15-21. DOI: 10.1159/000084860. View

Krainik A, Lehericy S, Duffau H, Capelle L, Chainay H, Cornu P . Postoperative speech disorder after medial frontal surgery: role of the supplementary motor area. Neurology. 2003; 60(4):587-94. DOI: 10.1212/01.wnl.0000048206.07837.59. View

Pollack I, Polinko P, Albright A, Towbin R, Fitz C . Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology. Neurosurgery. 1995; 37(5):885-93. DOI: 10.1227/00006123-199511000-00006. View

Siffert J, Poussaint T, Goumnerova L, Scott R, LaValley B, Tarbell N . Neurological dysfunction associated with postoperative cerebellar mutism. J Neurooncol. 2000; 48(1):75-81. DOI: 10.1023/a:1006483531811. View

Ersahin Y, Yararbas U, Duman Y, Mutluer S . Single photon emission tomography following posterior fossa surgery in patients with and without mutism. Childs Nerv Syst. 2002; 18(6-7):318-25. DOI: 10.1007/s00381-002-0614-z. View

Robertson P, Muraszko K, Holmes E, Sposto R, Packer R, Gajjar A . Incidence and severity of postoperative cerebellar mutism syndrome in children with medulloblastoma: a prospective study by the Children's Oncology Group. J Neurosurg. 2006; 105(6 Suppl):444-51. DOI: 10.3171/ped.2006.105.6.444. View

10.

McMillan H, Keene D, Matzinger M, Vassilyadi M, Nzau M, Ventureyra E . Brainstem compression: a predictor of postoperative cerebellar mutism. Childs Nerv Syst. 2008; 25(6):677-81. DOI: 10.1007/s00381-008-0777-3. View

11.

Crutchfield J, Sawaya R, Meyers C, Moore 3rd B . Postoperative mutism in neurosurgery. Report of two cases. J Neurosurg. 1994; 81(1):115-21. DOI: 10.3171/jns.1994.81.1.0115. View

12.

Ersahin Y . Is splitting of the vermis responsible for cerebellar mutism?. Pediatr Neurosurg. 1998; 28(6):328. DOI: 10.1159/000028673. View

13.

Ozgur B, Berberian J, Aryan H, Meltzer H, Levy M . The pathophysiologic mechanism of cerebellar mutism. Surg Neurol. 2006; 66(1):18-25. DOI: 10.1016/j.surneu.2005.12.003. View

14.

Chung H, Chou M, Chen C . Principles and limitations of computational algorithms in clinical diffusion tensor MR tractography. AJNR Am J Neuroradiol. 2010; 32(1):3-13. PMC: 7964942. DOI: 10.3174/ajnr.A2041. View

15.

Mochizuki H, Saito H . Mesial frontal lobe syndromes: correlations between neurological deficits and radiological localizations. Tohoku J Exp Med. 1990; 161 Suppl:231-9. View

16.

De Smet H, Baillieux H, Catsman-Berrevoets C, De Deyn P, Marien P, Paquier P . Postoperative motor speech production in children with the syndrome of 'cerebellar' mutism and subsequent dysarthria: a critical review of the literature. Eur J Paediatr Neurol. 2007; 11(4):193-207. DOI: 10.1016/j.ejpn.2007.01.007. View

17.

Rueckriegel S, Hernaiz Driever P, Blankenburg F, Ludemann L, Henze G, Bruhn H . Differences in supratentorial damage of white matter in pediatric survivors of posterior fossa tumors with and without adjuvant treatment as detected by magnetic resonance diffusion tensor imaging. Int J Radiat Oncol Biol Phys. 2009; 76(3):859-66. DOI: 10.1016/j.ijrobp.2009.02.054. View

18.

Le Bihan D, Mangin J, Poupon C, Clark C, Pappata S, Molko N . Diffusion tensor imaging: concepts and applications. J Magn Reson Imaging. 2001; 13(4):534-46. DOI: 10.1002/jmri.1076. View

19.

Rekate H, Grubb R, Aram D, Hahn J, Ratcheson R . Muteness of cerebellar origin. Arch Neurol. 1985; 42(7):697-8. DOI: 10.1001/archneur.1985.04060070091023. View

20.

Catsman-Berrevoets C, van Dongen H, Mulder P, Paz Y Geuze D, Paquier P, Lequin M . Tumour type and size are high risk factors for the syndrome of "cerebellar" mutism and subsequent dysarthria. J Neurol Neurosurg Psychiatry. 1999; 67(6):755-7. PMC: 1736675. DOI: 10.1136/jnnp.67.6.755. View